Laryngologist Lee Akst shares an overview of his expert lecture given at the AAO–HNSF virtual annual meeting, which details the differential diagnosis for globus pharyngeus. He provides an evidence- and case-based approach to reviewing all the potential causes of globus pharyngeus and advises providers to think beyond the diagnosis of reflux.
Hi, I'm Lee axed. I'm director of Langella T. Johns Hopkins and director of the Johns Hopkins Voice Center. I'm here to speak with you today and providing a summary of our American Academy of Otolaryngology course pains in the neck treating Globus for envious. This has been, of course, that I've been privileged for the last several years with my colleague Dr Seth Daily, who's learned biologists at the University of Wisconsin. And in this course, which is available to you on the American Academy of Otolaryngology website. We detail a differential diagnosis for global French IUs and take a very evidence based approach and case based approach to reviewing all the different things that can cause global friend Jesus because it really is a pain in the neck, a pain in the neck, quite literally for the patients. You've got the patient's complaint of that foreign body sensation, mucus sensation, fullness in their throat in their pharynx, but a pain in the neck for the provider when this patient comes back to you again and again and again without having had the improvement that he or she is looking for. And part of the issue is that I think a lot of us have been taught to think when we see a patient with global French es of reflux and we think of reflux first. But we maybe think of reflux last, and we think of nothing beyond reflux and are knee jerk. Reaction is to provide this patient with proton pump inhibitors, and the problem with that approach to global us is that we know what Onley fixes. About 50% of patients with globes for NGOs to take antacid medicine of that nature, And that's the same proportion of patients who would actually improve on placebo. So are we really helping them by giving every global patients P p I? And are we really helping them? And for subjecting them to the cost of that medication and the side effects of that medication without a demonstrated benefit beyond what a placebo might otherwise have offered in the course? And we detail the evidence for looking at reflux, but also other things like dryness, lesion, Sinus and allergic inflammation, a soft giggle, dis motility, esophageal spasm, quick Elendil, hyper tennis ity and sensory neuropathy. In an evidence based approach. Looking through each of these various categories and explanations of global friends. Yes. How do we get beyond just reflux? How do we treat some of those other things and you can treat each empirically? You can evaluate each with some more systematic evaluation if you choose not to treat empirically. But there are approaches Thio each of those things dryness, reflux, Sinus and allergic inflammation. Asafa Gee of this motility quick over NGO hyper tennis ity and then also, um, sensory neuropathy. There are ways on history. There are ways on physical exam to try to get towards the right answer. And that's what the course discusses. If that's something that's interesting to you, we welcome you to view and download the course online.
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